Debbie L Wilson

Identifying iatrogenic depression using confirmatory factor analysis of the Center for Epidemiologic Studies Depression Scale in patients prescribed a verapamil-sustained-release-led or atenolol-led hypertension treatment strategy

BACKGROUND β-blockers and calcium channel blockers are highly effective medications indicated for treatment and prevention of hypertension. However, the literature regarding the potential depressive effects of β-blockers and calcium channel blockers is equivocal regarding whether one or both are associated with depression. OBJECTIVES To determine whether self-reported depressive symptoms of older persons with hypertension and coronary artery disease and who were randomly assigned to a verapamil-sustained-release-led (Ve-led) or atenolol-led (At-led) hypertension treatment strategy were similar using confirmatory factor analytical models of the Center for Epidemiologic Studies Depression Scale (CES-D). METHODS This study used a mail survey of patients enrolled in a substudy of an international randomized controlled clinical trial. Complete data on the CES-D after 1 year of treatment were obtained from 1019 study subjects. Multiple group confirmatory factor analysis (CFA) procedures were used to test for differences in the fit of the data to the initial 4-factor CES-D model among patients assigned to the 2 treatment groups after 12 months of therapy. A test of configural invariance was conducted by sequentially constraining various matrices to be equal across groups. The convergent validity of the model was tested by examining the standard errors of the lambda-X parameter estimates of the configural model. The factor loadings for like items were investigated across the 2 groups using a test of strong factorial invariance. Finally, the 2 treatment groups were compared on the 4 factors to detect differences in the models parameters. RESULTS Overall, the data fit the CFA models across the 2 treatment groups based on the 4-factor model. However, 3 items differed slightly, including appetite, depressed, and crying. The data suggested significant differences across groups on the positive affect, interpersonal relations, and somatic and retarded activity latent variables. CONCLUSIONS The domains indicating less happiness and more depressive symptoms were most likely to be unfavorably impacted by the At-led treatment strategy. Given a choice between these equally effective high blood pressure treatment strategies, it may be prudent to use the Ve-led strategy. This is especially true if the risk of the occurrence of a mood-related side effect of the β-blocker outweighs its other benefits in comparison.

Defining “Pharmacy Technician”

Background: Legal definitions of “pharmacy technician” vary by state. Also, many pharmacy organizations have definitions of “pharmacy technician.” There is no consensus on the definition. Objective: To explore the legal definitions of a pharmacy technician and use of the term “professional judgment” in those definitions and develop an empirically and theoretically based definition of a pharmacy technician. Methods: Definitions of a pharmacy technician from the state statutes and regulations were found using LexisNexis State Capital and entered into an N-4 Classic database. The database was then coded through an iterative process of content analysis. A definition was developed using the content analysis and literature-based theory. Results: Definitions were found for 42 states (84%). Five main concepts were found to exist in the definitions: credentialing, designation, functions, practice site, and supervision. An empiric and theoretically based definition of a pharmacy technician was developed. Conclusions: Statutory and regulatory definitions of a pharmacy technician tend to define technicians in terms that preserve the dispensing role for pharmacists. Definitions of a pharmacy technician should focus on the types of services pharmacy technicians provide and the types of credentials they must have, rather than what they may not do and who they are not. The use of the term “professional judgment” in defining a pharmacy technician lacks precision and is therefore not helpful in defining “pharmacy technician.”

Investigation of the Potential Effects of Registration Requirements on Florida Pharmacy Technician Credentials

Background: On June 23, 2008, Florida adopted regulations mandating credentialing requirements for pharmacy technicians. Objective: To investigate the Pharmacy Technician Certification Board (PTCB) certified pharmacy technician self-report and pharmacist report of work experience, education, training, and non-PTCB certification credentials of Florida community pharmacy technicians prior to the adoption of registration requirements in that state and to predict the effects of the requirements on Florida pharmacy technicians. Methods: A self-administered questionnaire was mailed to 2000 Florida pharmacists and 2000 Florida PTCB Certified Pharmacy Technicians (CPhTs) in 2004. Results: Of the 1230 returned questionnaires, 571 (46%) were from pharmacists and 659 (54%) were from technicians. Most of the pharmacists in the sample reported that they had supervised a CPhT, while few had supervised a technician with an AA in Pharmacy Technician Sciences. Most of the technicians sampled reported having some higher education. Less than half reported having formal technician training. Few reported having non-PTCB pharmacy technician certificates. Conclusions: Florida pharmacy technicians had some higher education or technician training credentialing, despite its not being mandatory. Pharmacists may not always be aware of the education and credentials of the technicians they supervise. The new registration requirements will most likely have little effect on existing Florida pharmacy technicians who register before January 1, 2011. Those who are CPhTs will have to complete types of continuing education that are different from those that they were required to complete for certification. Those who are not CPhTs will have to complete continuing education programs.

From the States

According to the US Department of Labor Bureau of Labor Statistics, 211,000 pharmacy technicians held jobs in 2002 in the US. Two-thirds of these were in retail. While the number practicing in Florida is unknown, of the 163,793 Pharmacy Technician Certification Board (PTCB) pharmacy technicians certified since 1995, 9,542 live in Florida. Only one state, Texas, has more. The number of active PTCB-certified pharmacy technicians in Florida exceeds the number of active PTCB-certified pharmacy technicians in 20 of the 21 states (excluding Texas) that have PTCB certification in their regulations. This is due largely to the requirements, career ladders, and wage encouragements of the large chain pharmacy employers in Florida. Forty-three states define “pharmacy technician” in their state statutes and regulations. Although Florida does not define “pharmacy technician,” it does have a statute on pharmacy technicians that is similar to a definition of a pharmacy technician in that it describes how pharmacy technicians can be used. The statute details that a licensed pharmacist may delegate certain tasks to pharmacy technicians, that pharmacy technicians perform those delegated tasks under the direct supervision of a licensed pharmacist, and that the ratio of pharmacy technicians to pharmacists is 1:1 unless permission is obtained for more, with the maximum being 3:1. The objective of this study is to investigate the regulations of Florida pharmacy technicians that Florida could change or adopt. Methods

Review of Continuing Education and Published Literature Related to Women’s Health and Pharmacy

Background: In 2004, the American Association of Colleges of Pharmacy and collaborating organizations created a framework for women’s health instruction as a guide for integrating women’s health into pharmacy curricula. This article expands on the findings of that project by identifying educational opportunities with a women’s health focus that are available for pharmacists. Objective: To review educational opportunities available to pharmacists related to women’s health and to review the pharmacist’s role in women’s health in the published literature. Methods: The continuing education requirements for each of the 50 states and the District of Columbia were reviewed, and a search of continuing education programs for pharmacists on women’s health was conducted. A review of published literature about pharmacy and women’s health was conducted. Results: One state had a continuing education requirement related to emergency contraception, and 62 continuing education programs were found to have a focus on women’s health. The literature review returned 331 articles describing the role of pharmacy in women’s health, of which 55 were included. Conclusions: Pharmacists across different practice settings have a role in women’s health care. There is much emphasis placed on the pharmacist’s role in relation to contraception but increased education in other topics is also important. National pharmaceutical organizations can promote women’s health education for pharmacists.